Tantrums: A-to-Z Guide from Diagnosis to Treatment to Prevention

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Related concepts:

Temper tantrums, Emotional storms

Introduction to tantrums:

When your child kicks and screams at not getting his way, the outburst often seems to come at the least opportune times: during grocery shopping, when you’re on the phone, when you’re trying to get out the door, trying to make dinner, or at a family gathering.

What are tantrums?

Temper tantrums are expressions of intense, immediate frustration. They occur most frequently at an age when children’s verbal skills are inadequate to express their roiling emotions.
Gradually, after a child has mastered walking, an irresistible urge to make his own choices begins to well up inside him. This is an exciting development, but to make an independent choice he must disagree with you in order for the choice to be his own. Now, when you ask him to do something, part of him wants to please you, but part of him wants to refuse.

Many people call this important phase of development the “Terrible Twos.” I prefer to call it “The First Adolescence.” This period begins long before age two and actually continues long afterwards, but in the majority of children, it is most intensely focused around the period from one-and-a-half to three years of age.

The hallmark of this stage is oppositional behavior. Our wonderful children instinctively want to do exactly the opposite of what we want. We have nice, reasonable expectations and they say “NO!” or they simply dissolve into tears. Suppose you have some place to get to in a hurry. Your son has been in a great mood all day until you say, “I need you to get into the car right now.” He will, of course, want to do anything but get into the car.

As if this weren’t enough, children in this phase of development have a great deal of difficulty making the choices they so desperately want to make. You ask your child what he would like for dinner and he says macaroni. You lovingly prepare it for him and then as soon as it’s made he says, “I don’t want that!” It is perfectly normal for him to reverse a decision as soon as he has made it, because at this stage, he even disagrees with himself.

This phase is difficult for parents but it’s also hard for children. When children take a stand that opposes their parents, they experience intense emotions. Although they are driven to become their own unique persons, they also long to please their parents. Even now, when I do something that my parents disagree with, I feel very conflicted. I am an adult, living in a different city, with well-thought-out choices, and it is still quite difficult. For a child who is tentatively learning to make choices, who is dependent on his parents for food, shelter, and emotional support, it’s even more intense. Dissolving into tears is an appropriate expression of the inner turmoil that is so real for children who are in the midst of this process.

This season of emotional outbursts in children is reminiscent of labor – a series of intense spasms that ushers in a whole new phase of life.

Who gets tantrums?

Children going through this volatile developmental stage are most likely to get frustrated and have a tantrum when the intensity of the immediate situation increases. The excess stimulation may be visual, auditory, tactile, or a combination. It often includes being confronted with a bewildering array of choices, or being unable to get the attention or the desired, chosen outcome.

Let’s look at the example of the grocery store. As an adult, you can choose whether or not you want to go to the grocery store, when to go, what products you are going to buy, and which products you will not purchase. When you are in the middle of shopping in the grocery store, your child will see things he wants. To make the supermarket situation worse, there are cleverly designed packages up and down the aisles that scream, “Buy me! Buy me! Buy me!” We are largely able to tune that out, although it affects us much more than we think. For a small child who is just learning to make choices, it’s like going to a deafening rock concert. They are visually overwhelmed by high-decibel choices. They are compelled to start wanting multiple attractive items. When they can’t have what they want, they dissolve into tears and worse — deafening screams. Of course everybody in the store turns and looks at your child and (shudder) at you!

Almost all healthy children will have a number of temper tantrums but will eventually discard them as they find better strategies.

Those with ongoing tantrums often have reason for ongoing frustration or they have discovered that tantrums work! If children get the desired attention or outcome from their tantrums, they can become a powerful habit. Often these tantrums only occur when the parents are present.

What are the symptoms of tantrums?

A child may be acting ‘out of sorts’ before the tantrum begins. Then he asks for something he can’t have, can’t make up his mind, or tries to do something, but fails. Crying, perhaps screaming, will result. Some kids flail the arms and kick the legs. Some throw themselves on the ground. Some cry hard enough to vomit (making their parents desperately want to give in). Others will hold their breath – even to the point of passing out.

Are tantrums contagious?

Tantrums are not contagious, although the behavior of those around a tantrum can play into it.

How long does tantrums last?

Most children outgrow frequent tantrums by the time their language is mostly understandable to strangers.

How are tantrums diagnosed?

Tantrums are not a diagnosis. They are a normal phase of development, though they may be more prolonged, more frequent, or more intense in some children.

How are tantrums treated?

Realize that tantrums are an expression of acute frustration. They deserve a medium amount of attention (children should not feel that they get more of your attention by throwing a fit). Parents may be tempted to be loud or angry, but tantrums are a time to be calm.

First, take a deep breath. I’ve been in a grocery store with my children having temper tantrums, as a pediatrician, with my patients in the checkout line. The first thing you feel is, “I just wish I could drop into the floor so nobody would see me.” Many people won’t understand. They will look at you and think your child is spoiled or that you are a bad parent. The truth of the matter is that you probably have a normal child and are a good parent.

People who don’t have kids may not understand, yet. That is their problem, though. Try to be patient with them.

When I see a parent whose child is having a tantrum in a store, I am reminded of labor. When I look at a mom in labor, I see something that is heroic, triumphant, and beautiful. Tears come to my eyes when I am privileged to be a part of a birth. So, the next time this painful situation happens to you, take a deep breath and remember: if Dr. Greene were here, he would see something heroic and beautiful.

Next, while you are taking a deep breath, consciously relax. Kids play off your emotions. It’s so hard to relax in this situation, but just let your muscles go. The more uptight you are, the more energy is available for their tantrums. Kids thrive on attention, even negative attention.

Where you go from here depends on your child. Some children will calm down if you pick them up and hold them. My first son was like that. His storm would dissolve if you just gave him a big hug and told him it would be all right. If you picked up my second son during a storm, he would hit you — there were different ways to get him to calm down. Each child is unique.

One thing that often works very well is to try to voice to the child what he is going through. “You must really want to get this, don’t you?” Then he may melt and say, “Uh huh.” Because temper tantrums come from the inner turmoil that a child is facing. voicing their inner thoughts can often help diffuse the situation.

Handle tantrums with a light touch. Seasoning the interaction with understanding, humor, and distractions can save the day. When my oldest would ask, for the umpteenth time, for me to buy him something, I would smile and say, “Uh oh! I think someone has a case of the ‘gimmies’! Quick, let‘s go to the doctor!” It has become a lighthearted way for me to acknowledge his request, but still say “no.”

You will have to experiment with your child to see what it is that can help him understand that everything is okay, these bad feelings will pass, and that it’s all a normal part of growing up.

Whatever you do, if your child had a temper tantrum to try to get something, don’t give it to him, even if you would have ordinarily done so. Giving in to tantrums is what spoils a child. Giving in is the easiest, quickest solution in the short run, but it damages your child, prolongs this phase, and ultimately creates far more discomfort for you. Choosing your son’s long-term gain over such dramatic short-term relief is part of what makes properly handling temper tantrums so heroic.

How can tantrums be prevented?

Children are most susceptible to storms when they are tired, hungry, uncomfortable, bored, or over-stimulated.

Be creative at orchestrating life to minimize tantrum weather. You may want a toy basket that only comes out when you are on the phone or online. Dinner preparation is a great time for your child to watch an entertaining video.

When possible, plan shopping for times when your child is rested, fed, and healthy. Interact with your son throughout shopping and/or bring along stimulating toys or books.

Remember the situation from your child’s perspective. You are going along making choice, after choice, after choice, but when he tries to make a choice, he doesn’t get what he wants. You can see how frustrating this would be. It’s often helpful to let your child pick out one or two things when at the store. A good way to do this is when a child asks for something, instead of saying, “No,” (which will immediately make him or her say, “Yes!”) say, “Let’s write that down.” Then write it down. When your child asks for something else, write that down, too. Then when you are all done, read back a few of the things on the list that you think would be good choices, and let him pick one or two of the things on the list. If children can make some choices, they will learn more and feel better.

Another worthwhile technique is for you to make a list before you go to the store. That way it won’t look so arbitrary when you pick what you want off the shelf while your child doesn’t get his choice. As you shop, whenever you put something in your basket, check it off your list. Even if it is not on your list, check it off. The list is to teach that each item has a purpose, not that you had thought of it previously.

His task during this time is to gain skill at making appropriate choices. To help him accomplish this, offer your son limited choices at every opportunity. He will be demonstratively frustrated when he is given direct commands with no options. He will decompensate if he has too many alternatives. Two or three options generally work best.

Make sure the choices you offer fall within an appropriate agenda. Your son still needs the security of knowing that he’s not calling all the shots. When it’s time to eat, say something like, “Would you rather have a slice of apple or a banana?” He feels both the reassuring limits that you set and the freedom to exercise his power within those limits. If there are two things he needs to do, let him decide which to do first, when appropriate.

Dr. Greene is the founder of DrGreene.com (cited by the AMA as “the pioneer physician Web site”), a practicing pediatrician, father of four, & author of Raising Baby Green & Feeding Baby Green. He appears frequently in the media including such venues as the The New York Times, the TODAY Show, Good Morning America, & the Dr. Oz Show.